中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2011年
4期
344-347
,共4页
张丽志%温克%李虹%张洪%王得玲
張麗誌%溫剋%李虹%張洪%王得玲
장려지%온극%리홍%장홍%왕득령
子痫前期%不良结局%临床特征%母婴预后%危险因素
子癇前期%不良結跼%臨床特徵%母嬰預後%危險因素
자간전기%불량결국%림상특정%모영예후%위험인소
Pre-eclampsia%Adverse outcomes%Clinical features%Prognosis of mother and baby%Risk factors
目的 探讨重度子痫前期发生不良结局患者的临床特征及危险因素分析.方法 选择2008年1月至2009年12月在天津市第一中心医院住院的重度子痫前期并发不良结局149例为观察组,同期住院的重度子痫前期未发生不良结局278例为对照组,比较临床特征及分析不良结局的危险因素.结果 (1)一般资料:2组年龄、产次比较差异无统计学意义;观察组发病孕周、终止孕周均小于对照组差异均有统计学意义(P均＜0.05＝;观察组与对照组无规律产检率比较差异亦有统计学意义(x2=8.515,P=0.002).(2)临床特征及化验指标:观察组尿蛋白定性试验及水肿程度高于对照组,胎儿生长受限发生率更高,差异均有统计学意义(P均＜0.05＝.观察组间接胆红素、总胆红素、天冬氨酸氨基转移酶、丙氨酸氨基转移酶、尿酸、肌酐、白细胞、凝血酶时间、D-二聚体均高于对照组;白蛋白、血小板及纤维蛋白原低于对照组,差异均有统计学意义(P均＜0.05＝.(3)影响因素分析:logistic多因素分析回归分析显示发病孕周、规律产检与子痫前期并发不良结局关系最大(分别为OR=0.899,P＜0.001;OR=0.600,P=0.022＝;各种化验指标中,间接胆红素及D-二聚体与子痫前期并发症关系最显著(分别为OR=1.533,P=0.010;OR=1.001,P=0.003).眼底病变与平均动脉压及肌酐水平关系最大(分别为OR=1.030,P=0.048;OR=1.025,P=0.022).胎死宫内与规律产检最大(OR=0.317,P=0.046).(4)母儿预后:2组剖宫产率差异无统计学意义(P＞0.05).观察组娩出低出生体重儿率高于对照组,观察组新生儿评分明显低于对照组;观察组产时出血高于对照组,差异均有统计学意义(P均＜0.05＝.结论 发病孕周过早、无规律产检及出现胎儿窘迫是子痫前期并发不良结局的高危因素.间接胆红素及D-二聚体增高应警惕子痫前期不良结局发生.
目的 探討重度子癇前期髮生不良結跼患者的臨床特徵及危險因素分析.方法 選擇2008年1月至2009年12月在天津市第一中心醫院住院的重度子癇前期併髮不良結跼149例為觀察組,同期住院的重度子癇前期未髮生不良結跼278例為對照組,比較臨床特徵及分析不良結跼的危險因素.結果 (1)一般資料:2組年齡、產次比較差異無統計學意義;觀察組髮病孕週、終止孕週均小于對照組差異均有統計學意義(P均＜0.05＝;觀察組與對照組無規律產檢率比較差異亦有統計學意義(x2=8.515,P=0.002).(2)臨床特徵及化驗指標:觀察組尿蛋白定性試驗及水腫程度高于對照組,胎兒生長受限髮生率更高,差異均有統計學意義(P均＜0.05＝.觀察組間接膽紅素、總膽紅素、天鼕氨痠氨基轉移酶、丙氨痠氨基轉移酶、尿痠、肌酐、白細胞、凝血酶時間、D-二聚體均高于對照組;白蛋白、血小闆及纖維蛋白原低于對照組,差異均有統計學意義(P均＜0.05＝.(3)影響因素分析:logistic多因素分析迴歸分析顯示髮病孕週、規律產檢與子癇前期併髮不良結跼關繫最大(分彆為OR=0.899,P＜0.001;OR=0.600,P=0.022＝;各種化驗指標中,間接膽紅素及D-二聚體與子癇前期併髮癥關繫最顯著(分彆為OR=1.533,P=0.010;OR=1.001,P=0.003).眼底病變與平均動脈壓及肌酐水平關繫最大(分彆為OR=1.030,P=0.048;OR=1.025,P=0.022).胎死宮內與規律產檢最大(OR=0.317,P=0.046).(4)母兒預後:2組剖宮產率差異無統計學意義(P＞0.05).觀察組娩齣低齣生體重兒率高于對照組,觀察組新生兒評分明顯低于對照組;觀察組產時齣血高于對照組,差異均有統計學意義(P均＜0.05＝.結論 髮病孕週過早、無規律產檢及齣現胎兒窘迫是子癇前期併髮不良結跼的高危因素.間接膽紅素及D-二聚體增高應警惕子癇前期不良結跼髮生.
목적 탐토중도자간전기발생불량결국환자적림상특정급위험인소분석.방법 선택2008년1월지2009년12월재천진시제일중심의원주원적중도자간전기병발불량결국149례위관찰조,동기주원적중도자간전기미발생불량결국278례위대조조,비교림상특정급분석불량결국적위험인소.결과 (1)일반자료:2조년령、산차비교차이무통계학의의;관찰조발병잉주、종지잉주균소우대조조차이균유통계학의의(P균＜0.05＝;관찰조여대조조무규률산검솔비교차이역유통계학의의(x2=8.515,P=0.002).(2)림상특정급화험지표:관찰조뇨단백정성시험급수종정도고우대조조,태인생장수한발생솔경고,차이균유통계학의의(P균＜0.05＝.관찰조간접담홍소、총담홍소、천동안산안기전이매、병안산안기전이매、뇨산、기항、백세포、응혈매시간、D-이취체균고우대조조;백단백、혈소판급섬유단백원저우대조조,차이균유통계학의의(P균＜0.05＝.(3)영향인소분석:logistic다인소분석회귀분석현시발병잉주、규률산검여자간전기병발불량결국관계최대(분별위OR=0.899,P＜0.001;OR=0.600,P=0.022＝;각충화험지표중,간접담홍소급D-이취체여자간전기병발증관계최현저(분별위OR=1.533,P=0.010;OR=1.001,P=0.003).안저병변여평균동맥압급기항수평관계최대(분별위OR=1.030,P=0.048;OR=1.025,P=0.022).태사궁내여규률산검최대(OR=0.317,P=0.046).(4)모인예후:2조부궁산솔차이무통계학의의(P＞0.05).관찰조면출저출생체중인솔고우대조조,관찰조신생인평분명현저우대조조;관찰조산시출혈고우대조조,차이균유통계학의의(P균＜0.05＝.결론 발병잉주과조、무규률산검급출현태인군박시자간전기병발불량결국적고위인소.간접담홍소급D-이취체증고응경척자간전기불량결국발생.
Objective To explore clinical features of severe preeclampsia patients with adverse outcome, and the risk factors of adverse outcomes. Methods From Jan. 2008 to Dec. 2009 149 severepreeclampsia impatients who occurred adverse outcome enrolled as case,and 278 severe preeclampsia impatientswithout adverse outcome at the same period enrolled as control. The clinical features between the two groups were compared and the risk factors were investigated. Results No significant differences were found between the two groups in maternal age,times of previous prenancies. The gestation ages at the onset of preeclampsia and at delivery in the cases were less than controls(P ＜ 0. 05). There was significant difference in irregular antenatal checks between the two groups(x2 = 8. 515, P ＜ 0. 05). Proterinuria and the level of oedema in cases were higher than controls( P ＜ 0. 05). Fetal growth restriction (FGR) occurred more frequently in the cases (P ＜0. 05). Indirect bilirubin, total bilirubin, glutamic oxalacetic transaminase, glutamic pyruvic transaminase, uric acid, creatinine, white blood cell, thrombin time, D-dimeride of cases were higher than those of controls(Ps ＜0. 05). Albumin, platelet and profibrin of cases were lower than those of controls(Ps ＜ 0. 05 ＝. Multivariate logistic analysis showed that the gestation ages at the onset of preeclampsia, regular antenatal checks were significantly associated with adverse outcome(OR = 0. 899, P ＜ 0. 001; OR = 0. 600, P = 0. 022, respectively ＝Indirect bilirubin and D-dimeride were significantly associated with preeclampsia complications(OR = 1. 533,P =0. 010; OR = 1.001, P = 0. 003, respectively). Mean arterial pressure and creatinine were significantly associated with eyeground changes(respectively OR = 1. 030,P = 0. 048; OR = 1. 025, P = 0. 022, respectively).Regular antenatal checks was associated with dead fetus(OR = 0. 317, P = 0. 046). No significant differenceswere found between the two group in uterine-incision delivery(P ＞ 0. 05). Incidence rate of low birth weight infants and postpartum hemorrhage of cases were higher than controls and Apgar score was lower in cases than controls( all P ＜0. 05＝. Conclusion The gestation ages at the onset of preeclampsia,regular antenatal checks,fetal distress were risk factors for preeclampsia adverse outcome. Patients with.high indirect bilirubin and Ddimeride are more likely to suffer adverse pregnancy outcomes.
